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~~.perwork ~e~~ction Act Notice
<br />?trblic reporting burden for this collection of information is estimated to vary from a range of 10 hours as an
<br />average per response for some minor facilities, to 110 Lours as an average per response for some major
<br />facilities, with a ~~7eighted average for major and minor faciliries of 18 hours per response, including time for
<br />reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and
<br />ccmpleting and reviewing the collection of information, including suggestion for reducing this burden, to
<br />Cltief, Information Policy Branch, PM-223, U.S. Environmental Protection Agency, 401 M Street, S.W.
<br />Washington, DC 20460; and to the Cffice of Information and Regulatory Affairs, Office of Management and
<br />Budget, Washington, DC 20503.
<br />General Ia~structions
<br />1. [f form has been partiaf[y completed by preprinting, disregard instruction directed at entry of that information already
<br />Preprinted.
<br />2. Enter "Permittee Name/Nai/ing /tddress (and facility nameAocafion, if different)," " Permit NumEer," and "Dis~h~rgs
<br />Number" where indicated. (A separate form is required for each discharge.)
<br />3. Enter dates beginning and editing "ivionitoring Peri , /"coveted by form where indicated.
<br />4. Enter each "Farynerar" as specified in monitoring requirements of permit.
<br />?. Snter "S:nrple Il•L,uw•mtent"data Cor each paramc4:r under "~ul:uity" and ~%u~lir)-" as specified in permit. "Ara,,rbs" is
<br />normally arithmetic average (geometric average for bacterial pummeters) of all samp', meastvemen+s for each pa: a-netcr
<br />obtained duri;.g "; r; ~aiP,rin;; F,:ric.l'; "iv;lxisnmr" and irlini.truu," ar,: normally ea~rcmc Sigh and lo~.v mcas u;emcob
<br />outaincd du.-iiig ",'J,•.nrh ri,r; i-'~rioJ". (Note to nwnici;,als v~th secondary treatment nyuircment: l~h:r 30~xy average
<br />of k.- ~nlc mcasurem, nts under 'il vzrage,"and c~tcr nnximun 7-i~.y Overage of s3mplc measr±-err~nts obt3lnad c ~riry
<br />moaitoring period under "iviaximum.")
<br />f~. _..,: "h ~~;,,i! t4'; r4-~nr •„+" for each psram~tcr under "C/nJntlN" sod "r:rra!iry" as cpccified i i perm',
<br />'. Under "hro t-a" cote- m..r,ucr o; sample ~;v.:..tiure:r.;n: u~~ring mon4o~i~~y; ~:~ricd li~~.t, :acted m.L imJOl (anwer tnir~^•un~
<br />or ~-dcy . ~: crage as appropriate) permit regwnmcut rn~ each pcramelcr. If none, enter "0 ".
<br />F. i.~:'e- "F;~,r;u.=: ,~ -~ .',uiysis" boflr as '8...:;-l. '.':~~rran.•ar" ;actua: i~cyucncy of ;.^•~piing ;, id rna~ysis use[ dur:u~
<br />no.r;m Ong ner~ud) ~u•ii as "T.n;rit R,uri•-:u, -r.:"spcuif,ed in p..mrit. (, .d. Enter "_ , ,' for ccnL iuo~ n'.oaiturno, "1/7"
<br />rc,r uec Lay p:' v: ec!c, "1/30" ice cnc clay per icocib, "1170" for one duy per yuzrtc,, eb~)
<br />Sr. '.ac: "S, n,/'- i ;~_"bush as "Sta,/!z i~',-~re,~,;ura" (cctual sample type us_d during •-;onituring pc.ied) and as "F_•,-uri:
<br />IL•.lrir_srs;d." (c.o. later "Guh" for ~ndividu~l sample, ".?4f/i:" for Z4-hm~r coinnosite, ".Y/F," for eorltnuous
<br />monitoring, etc.)
<br />0. 1Vhere violutioos of permit requirements arc rportcd, attch a brief explana;ion to c'acribe cause anr: ccn'cc'ivc ,c;;u•s
<br />to ba i~.ken, and reference eacL violation by date.
<br />11. 'f"nc discharge" occurs tl: -ing monitorno period, en.cr "No Discha-gd' across form in place of data cony.
<br />I2. 3ntcz "A.tanJTitL- sf Frin::iF~! L~ra_,rtii.a rf-•_~•" with "Si,n_uure r,f t=rio:i7at Fr__^.rlirs OJji:er of Atr65orizec/
<br />figent. ""Tali ph ,n_ Arumho•, "and "Gars" at bottom o f furor.
<br />13. ivlail signed Report to Of ice(s) by date(s) specified in permit. Retain copy for your records.
<br />14. 1Jorc detailed instructions for use of this Gis~larga Alotritorirrg fZy:~rr (J,t-f~ farm may be ob~ined from OCGa:(s)
<br />specified in permit.
<br />Legal Notice
<br />'T'his report is required by law (33 U.S.C. 1318; 40 C.F.R. 125.27). Failure to report or failure to report truthfully can result in
<br />:lull penalties not to exceed $10,000 per day of violation; or in criminal penalties not to exceed $25,000 per day of violation,
<br />or by imprisonment for not more than one year, or both.
<br />EPA Form 3320-1 (Rev. 03/99]
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